alpha1-adrenoceptor antagonists are first-line agents for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia, while their adverse effects on sexual function are reported frequently in recent years, especially the induction of ejaculatory dysfunction. This review presents the distribution of alpha 1-adrenoceptors in the male genital system and the relationship of alpha1-adrenoceptors with ejaculatory function. It also highlights the interesting phenomenon of ejaculatory dysfunction related to these drugs and its possible mechanism, with the intention to provide some essential clues for further research on this problem as well as some references to safer use of these drugs in clinical settings.
Adrenergic alpha-1 Receptor Antagonists ; Adrenergic alpha-Antagonists ; adverse effects ; pharmacology ; Ejaculation ; physiology ; Erectile Dysfunction ; chemically induced ; physiopathology ; Humans ; Male ; Receptors, Adrenergic, alpha-1 ; physiology

Benign prostatic hyperplasia (BPH) is a common senile disease, and its main clinical manifestation is lower urinary tract symptom (LUTS), which has long been afflicting old male patients. Previous study showed that alpha1-receptor in the prostate was involved in the development of LUTS. At present, alpha1-receptor blocker is generally accepted as a choice drug for treating BPH and relieving LUTS. The article reviews the tissue distribution of alpha1-receptor and clinical application of alpha1-receptor blocker.
Adrenergic alpha-1 Receptor Antagonists ; Adrenergic alpha-Antagonists ; adverse effects ; pharmacokinetics ; therapeutic use ; Humans ; Male ; Prostatic Hyperplasia ; drug therapy ; Receptors, Adrenergic, alpha-1 ; analysis

The epidemiological survey shows that primary hypertension is one of the independent risk factors in the development and the progress of BPH, 25 percent of old male patients aged 60 or more suffer from the two diseases at the same time, which grievously affects their quality of life. There is little literature about the appropriate therapeutic regimen of BPH associated hypertension. The article reviews the progress in the studies of alpha1-adrenoceptor blocker for BPH associated hypertension, and explores the main problems facing us and ventures the prospects for the development in this field.
Adrenergic alpha-1 Receptor Antagonists ; Adrenergic alpha-Antagonists ; adverse effects ; therapeutic use ; Aged ; Aged, 80 and over ; Humans ; Hypertension ; complications ; drug therapy ; Male ; Middle Aged ; Prazosin ; adverse effects ; analogs & derivatives ; therapeutic use ; Prostatic Hyperplasia ; complications ; drug therapy

OBJECTIVESTo evaluate the clinical efficacy and safety of Naftopidil tablet in treating benign prostatic hyperplasia.

METHODSEighty BPH patients were divided into two groups randomly by double-blind, double-simulated and active control parallel study trials. Forty patients in treatment group were given Naftopidil tablet 25 mg, p.o., qn for 42 days, while 40 patients in control group were given Tamsulosin 0.2 mg, p.o., qn for 42 days. Statistical analysis was given from 77 cases in the groups. Estimation of the efficacy was done by the change of major indexes include international prostate symptom score (IPSS), maximum flowrate (Qmax) and secondary indexes such as quality of life (QOL), residual urine (Ru) and volume of prostate (V).

RESULTSThe changes of IPSS, Qmax, QOL had significant difference between two groups before and after treatment(P < 0.05). The change of Ru had no significant difference between two groups before and after treatment (P > 0.05) while there was significant difference between two groups after six-week treatment(P < 0.05). The change of V had no significant difference (P > 0.05). The adverse reactions in both groups were mild, and there was no significant difference between two groups(P > 0.05).

CONCLUSIONSNaftopidil tablet was safe and effective in treating benign prostatic hyperplasia.

Adrenergic alpha-1 Receptor Antagonists ; Adrenergic alpha-Antagonists ; therapeutic use ; Aged ; Double-Blind Method ; Humans ; Male ; Middle Aged ; Naphthalenes ; adverse effects ; therapeutic use ; Piperazines ; adverse effects ; therapeutic use ; Prostatic Hyperplasia ; drug therapy ; psychology ; Quality of Life ; Tablets

We describe a 56-year-old man who developed an acute liver injury after taking alfuzosin for 1 month to control his newly diagnosed benign prostatic hypertrophy (BPH). There was no history of alcohol consumption or the taking herbal or traditional remedies. Viral causes, autoimmune hepatitis, and biliary tree obstruction were excluded. Other rare causes of hepatitis such as hemochromatosis, primary biliary cirrhosis and Wilson's disease were also absent in this patient. His liver test results began to improve after discontinuing the alfuzosin. Two weeks later, alfuzosin was administered again because the patient complained of dysuria. After 10 days of alfuzosin reuse, his liver test results worsened. Five months later after the complete discontinuation of the drug, his liver test results had returned to normal. This clinical sequence suggests that alfuzosin caused his acute liver injury.
Acute Disease ; Adrenergic alpha-Antagonists/*adverse effects ; Dysuria/pathology ; Humans ; Liver Diseases/*chemically induced/pathology ; Liver Function Tests ; Male ; Middle Aged ; Prostatic Hyperplasia/drug therapy ; Quinazolines/*adverse effects

BACKGROUNDTamsulosin hydrochloride can significantly improve benign prostatic hyperplasia (BPH) symptoms after the first dose and achieve long-term efficacy in European and American populations; however, the corresponding studies from China are rarely seen. The purpose of this study was to evaluate the long-term efficacy and safety of tamsulosin hydrochloride 0.2 mg once daily in patients with lower urinary tract symptoms (LUTS) suggestive of BPH in China.

METHODSChinese patients with LUTS suggestive of BPH were enrolled in a 4-week placebo run-in period and subsequent 60-week open-label study. Tamsulosin hydrochloride 0.2 mg was administered daily during the period of the study. The efficacy and safety parameters were evaluated at the end of treatment period I (0 - 12 weeks) and period II (13 - 60 weeks). The BPH patients were divided into tamsulosin monotherapy group and combination therapy group which received concomitant medication of finasteride 5 mg once daily after the evaluation at the end of treatment period I.

RESULTSA total of 113 patients were recruited to the study. Eighty-two patients received tamsulosin monotherapy and twenty-nine received combination therapy during the treatment period II. Tamsulosin hydrochloride produced a great improvement in mean maximum urinary flow rate (Q(max)) (1.7 ml/s, 3 ml/s) and a significant decrease in mean international prostate symptom score (IPSS) (4.1, 6.4) after 12-week and 60-week treatments, respectively. At the end of treatment period II, there were significant improvement in IPSS, quality of life (QOL) score, Q(max) and average flow rate (Q(ave)) for combination therapy group compared with the treatment period I (all P < 0.05). No serious adverse events (SAE) were recorded during the study.

CONCLUSIONLong-term tamsulosin hydrochloride therapy is a safe, effective and well-tolerated method for the treatment for LUTS suggestive of BPH in China.

Adrenergic alpha-1 Receptor Antagonists ; adverse effects ; therapeutic use ; Aged ; China ; Humans ; Male ; Middle Aged ; Placebos ; Prostatic Hyperplasia ; drug therapy ; Prostatism ; drug therapy ; Sulfonamides ; adverse effects ; therapeutic use

ObjectiveTo investigate the therapeutic effects of commonly used selective &alpha;-adrenergic receptor antagonists (&alpha;-ARA) on benign prostatic hyperplasia (BPH).

METHODSPubMed, Embase and CNKI databases were searched for the literature about selective &alpha;-ARAs for the treatment of BPH and the information was extracted on the common adverse reactions in the course of treatment. Multivariate meta-analysis was conducted to investigate the therapeutic effects of different &alpha;-ARAs.

RESULTSThe total rates of adverse effects of silodosin and tamsulosin were the highest, 51.9% and 34.0% respectively, with the highest incidences of headache (38.3%), weakness (23.6%) and dizziness (17.5%). Besides, tamsulosin ranked the first in inducing sexual dysfunction of the male patients with BPH (70.4%).

CONCLUSIONSDoxazosin is preferable as the first-choice treatment of BPH for its therapeutic effect and improvement of the patient's quality of life. Silodosin and tamsulosin, however, can be selectively used according to the patient's specific tolerance to different adverse effects.

Adrenergic alpha-Antagonists ; adverse effects ; therapeutic use ; Doxazosin ; adverse effects ; therapeutic use ; Humans ; Indoles ; adverse effects ; therapeutic use ; Male ; Network Meta-Analysis ; Prostatic Hyperplasia ; drug therapy ; Quality of Life ; Sexual Dysfunction, Physiological ; chemically induced ; Tamsulosin ; adverse effects ; therapeutic use

OBJECTIVESTo evaluate a new effective treatment for prostatodynia (PD) and chronic non-bacterial prostatitis (CNP).

METHODSOne hundred and thirty-six patients suffered from PD or CNP were divided randomly into experiment group (n = 76), which were treated with external RF hyperthermia (ERFH) combining with alpha 1-adrenergic receptor blocker Terazosin for 12 weeks, and control group (n = 60), which were only treated with ERFH. Symptoms scores, urodynamic indexes and expressed prostate secretion were recorded pre- and post-treatments.

RESULTSMFR and AFR were significantly improved and symptoms scores significantly decreased in both groups (P < 0.05). The efficacy was better in experiment group than that in control group. The combination treatment also led to a significantly decrease in MUP and MUCP (P < 0.05). Additionally, the leucocytes in expressed prostate secretion were also reduced in experiment group (P < 0.05).

CONCLUSIONSTreatment of ERFH combining with alpha 1-adrenergic receptor blocker for patients with PD or CNP was effective and had little side-effect, while the future curative effect should be observed furtherly.

Adrenergic alpha-1 Receptor Antagonists ; Adrenergic alpha-Antagonists ; adverse effects ; therapeutic use ; Adult ; Chronic Disease ; Combined Modality Therapy ; Humans ; Hyperthermia, Induced ; Male ; Middle Aged ; Pain ; drug therapy ; etiology ; Pain Management ; Prazosin ; adverse effects ; analogs & derivatives ; therapeutic use ; Prostatitis ; complications ; drug therapy ; therapy

We evaluated the therapeutic effects of tamsulosin for women with non-neurogenic voiding dysfunction. Women who had voiding dysfunctions for at least 3 months were included. Inclusion criteria were age > or =18 yr, International Prostate Symptom Score (IPSS) of > or =15, and maximum flow rate (Q(max)) of > or =12 mL/sec and/or postvoid residuals (PVR) of > or =150 mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram as having no or mild obstruction (group A) or moderate or severe obstruction (group B). After 8 weeks of treatment, treatment outcomes and adverse effects were evaluated. One hundred and six patients were evaluable (70 in group A, 36 in group B). After treatments, mean IPSS, bother scores, Q(max), PVR, diurnal and nocturnal micturition frequencies and scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF) were changed significantly. Eighty-nine patients (84%) reported that the treatment was beneficial. The proportion of patients reported that their bladder symptoms caused "moderate to many severe problems" were significantly decreased. No significant difference were observed between the groups in terms of IPSS, bother score, Q(max), PVR, micturition frequency, and BFLUTS-SF changes. Adverse effects related to medication were dizziness (n=3), de novo stress urinary incontinence (SUI) (n=3), aggravation of underlying SUI (n=1), fatigue (n=1). Tamsulosin was found to be effective in female patients with voiding dysfunction regardless of obstruction grade.
Adrenergic alpha-Antagonists/adverse effects/pharmacokinetics/*therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Middle Aged ; Questionnaires ; Severity of Illness Index ; Sulfonamides/adverse effects/pharmacokinetics/*therapeutic use ; Treatment Outcome ; Urination Disorders/*drug therapy

BACKGROUNDThe primary objectives of the treatment for the lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are to produce rapid, sustained, and safe improvements in the symptoms that affect the quality of life in the majority of men over 50. In this study, we evaluated the efficacy and safety of the combined therapy with terazosin (apha1-adrenergic receptor antagonist) and tolterodine (anticholinergic agent) for LUTS associated with BPH.

METHODSThis combination study included 69 patients diagnosed with LUTS associated with BPH based on the International Prostate Symptom Scores (IPSS), urinary flow rate, prostate volume, urinary residual, and their serum prostate-specific antigen levels. Initially, 191 patients were treated with terazosin 2 mg once daily for one week. Those patients with continued LUTS after the initial treatment were allocated randomly into two groups: terazosin group (n = 36) in which patients were treated with terazosin 2 mg once daily for six weeks, and combination group (n = 33) in which patients were treated with both terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks.

RESULTSThe IPSS were significantly improved in both groups after treatment, and the reduction of IPSS in the combination group was significantly greater than that in the terazosin group (P < 0.01). A decrease in urgency, frequency and nocturia were the main contributory factors causing the reduction of IPSS in the combination group. The differences about the peak urinary flow rate and the residual urine from the baseline values were noted in both groups after treatment, but were not significant between the two groups. The incidence of adverse effects in the combination group was higher than that in the terazosin group. As expected the most common adverse effect was mouth dryness which was associated with anticholinergic drugs such as tolterodine.

CONCLUSIONSPatients with LUTS associated BPH appear the improved IPSS after combined therapy with terazosin and tolterodine. This study, although short term and limited numbers of patients, provides evidence that the combined therapy with terazosin plus tolterodine is a good approach for meeting the objectives of rapid, sustained, and safe improvements in the LUTS associated with BPH. And the profile of patients in this study might be used as the indication of such combined therapy for LUTS associated with BPH without urodynamic evaluation.

Adrenergic alpha-Antagonists ; administration & dosage ; Aged ; Benzhydryl Compounds ; administration & dosage ; adverse effects ; Cresols ; administration & dosage ; adverse effects ; Drug Therapy, Combination ; Humans ; Male ; Middle Aged ; Muscarinic Antagonists ; administration & dosage ; Phenylpropanolamine ; administration & dosage ; adverse effects ; Prazosin ; administration & dosage ; adverse effects ; analogs & derivatives ; Prospective Studies ; Prostatic Hyperplasia ; complications ; drug therapy ; Tolterodine Tartrate ; Urination Disorders ; drug therapy